Although we appreciate the visibility the Comment by Bolajoko Olusanya and colleagues (May, 2021)1Olusanya BO Hadders-Algra M Breinbauer C et al.The conundrum of a global tool for early childhood development to monitor SDG indicator 4.2.1. has given to the monitoring of early childhood development, it contains serious errors and omissions about Sustainable Develop Goal (SDG) processes and requirements, including failing to draw distinctions among population-level measures, global monitoring, and child-level assessments. Clarifying the scope and limitations of measurement tools is crucial to strengthening data on early childhood development.

The Comment makes the following erroneous statements: the decision to exclude children younger than 2 years from SDG 4.2.1 is attributed to UNICEF's inability to develop a measure for younger children; a fully validated population-level measure of early childhood development in children younger than 2 years (the Global Scale for Early Development [GSED]) is ready to use and UNICEF has ignored it; and that the Washington Group on Disability Statistics has not succeeded in producing a tool that includes all children.

The global indicator framework for the SDGs was developed by the Inter-Agency and Expert Group on SDG Indicators (IAEG-SDGs), and all decisions related to the framework are taken by this entity. The IAEG-SDGs comprises regionally representative UN member states; regional and international agencies and civil society are observers.2UN General Assembly
Resolution adopted by the General Assembly on 6 July 2017. 71/313. Work of the Statistical Commission pertaining to the 2030 Agenda for Sustainable Development. All SDG indicators were classified by the IAEG-SDGs into three tiers on the basis of their level of methodological development and the availability of data at the global level. SDG 4.2.1 was classified in 2016 as a tier 3 indicator for which no internationally established methodology or standards were available.

The IAEG-SDGs has tasked so-called custodian agencies for each SDG indicator to provide member states with support. All custodian agencies for tier 3 indicators were given 3 years (ie, until 2019), to develop adequate measures. As custodian agency for 4.2.1, UNICEF was tasked to develop a population-level measure that could be used by countries to produce internationally comparable data. At the time, methodological work (coordinated zby WHO) was already underway to identify questions that could be used to measure outcomes in early childhood development among children aged 0–36 months (the GSED). To avoid duplication of efforts and recognising that additional work was needed, UNICEF took on the task of developing a population-level measure for the aged 24–59 month population. To support its work, UNICEF created an interagency and expert group (the Inter-Agency and Expert Group on early childhood development [IAEG-ECD]) that brought together representatives of national statistical offices, international agencies, and academia.

During the ninth meeting of the IAEG-SDGs in March, 2019,3UN Department of Economic and Social AffairsStatistics Division
STA/441/2/162A: ninth meeting of the Inter-Agency and Expert Group on Sustainable Development Goals indicators. 26–28 March 2019. UNICEF presented the measure intended to capture outcomes in early childhood development among children aged 24–59 months—the Early Childhood Development Index 2030 (also known as ECDI2030). The new measure was approved at the meeting. WHO did not have a fully prepared instrument to present for the period from birth to 23 months; therefore, the IAEG-SDGs reclassified the 4.2.1 indicator as a multi-tier indicator: tier 2 (for which there is an internationally established methodology) for children aged 24–59 months and tier 3 for children aged 0–23 months.A further opportunity to present the work on tier 3 indicators occurred in May, 2019, after which a comprehensive review of the entire global indicator framework was conducted. To support this review, an online consultation open to civil society, academia, and the private sector took place to gather inputs on refinements and deletions to the framework. The IAEG-SDGs decided a tier 3 indicator should be deleted when the methodological work had stalled or not produced the expected results. At the 11th meeting of the IAEG-SDGs in November, 2020, it was noted that the methodology for measuring early childhood development from birth to 23 months, led by WHO, was still under development and not yet ready for implementation, so it was deleted.

We are in complete agreement with Olusanya and colleagues of the need to invest in the early identification of children with developmental delays and disabilities, but this identification requires an individual-level data system. For instance, household surveys produce valuable data at the population level, but the information they provide is not at the level of the individual child; household surveys are not designed to identify children in need of intervention.

The Child Functioning Module, developed by the Washington Group on Disability Statistics and UNICEF, is also intended to be used at the population level. The module was extensively reviewed by experts and was developed in consultation with organisations of individuals with disabilities who were instrumental in the design of the module, including through their engagement during its field validation.4International Disability Alliance
Joint statement by the disability sector: disability data disaggregation.The inclusion of questions regarding children younger than 2 years was one objective of the Child Functioning Module.5Loeb M Cappa C Crialesi R de Palma E Measuring child functioning: the UNICEF/Washington Group module. However, to date, no universal functioning questions have been identified for these children that could be implemented in surveys and that would elicit valid, reliable, and cross-nationally comparable results. Different tools and administration protocols will be needed to produce such results.

The Child Functioning Module and the ECDI2030 are population-level instruments developed for use in multitopic household surveys. They take into consideration psychometric properties and what is feasible to integrate into standard surveys. Such surveys have specific constraints and requirements, including the need to rely on simple questions that can be responded to by mothers or other primary caregivers. They must also include the shortest possible number of questions to provide a valid estimate at population level.

The data needs in this field are substantial and varied, and no single instrument exists that can address all these needs. Responding to such needs will take collective action.

I declare no competing interests.

References1.Olusanya BO Hadders-Algra M Breinbauer C et al.

The conundrum of a global tool for early childhood development to monitor SDG indicator 4.2.1.

Lancet Glob Health. 9: e586-e5872.

Resolution adopted by the General Assembly on 6 July 2017. 71/313. Work of the Statistical Commission pertaining to the 2030 Agenda for Sustainable Development.

3.UN Department of Economic and Social AffairsStatistics Division

STA/441/2/162A: ninth meeting of the Inter-Agency and Expert Group on Sustainable Development Goals indicators. 26–28 March 2019.

UN Department of Economic and Social Affairs, 4.International Disability Alliance

Joint statement by the disability sector: disability data disaggregation.

5.Loeb M Cappa C Crialesi R de Palma E

Measuring child functioning: the UNICEF/Washington Group module.

Salud Publica Mex. 59: 485-487Article InfoPublication HistoryIdentification

DOI: https://doi.org/10.1016/S2214-109X(21)00229-1

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© 2021 The Author(s). Published by Elsevier Ltd.

User License Creative Commons Attribution (CC BY 4.0) | ScienceDirectAccess this article on ScienceDirect Linked ArticlesThe conundrum of a global tool for early childhood development to monitor SDG indicator 4.2.1

The UN's Sustainable Development Goals (SDGs) agenda, by contrast to the Millennium Development Goals, provides a global policy framework to address the quality of life of beneficiaries of the remarkable reduction in mortality in those younger than 5 years since the child survival revolution began in 1982.1 The SDGs explicitly commit all governments and the global health community to actions that will “ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education”.

Full-Text PDF Open AccessSetting the record straight on measuring SDG 4.2.1 – Authors' reply

We appreciate the attention of Mark Hereward from UNICEF to the concerns in our Comment published in The Lancet Global Health,1 and wish to clarify some of the alleged omissions and errors. We, and members of the public, are not privy to the internal processes and procedures that have restricted the development of a tool that includes all children younger than 5 years as required by Sustainable Develop Goal (SDG) 4.2.1, and that the component relating to children younger than 24 months is now the sole responsibility of WHO.

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